Disability Insurance

Rescinded 1975

The claimant was determined to be under a disability as of December 1,
1963, based on the medical findings indicating arteriosclerotic heart
disease, manifested by angina pectoris, and congestive heart failure. In
September 1965 objective medical tests revealed no signs suggesting heart
failure, no indications of heart block or diagnostic abnormality and that
her condition had improved. The examining physician indicated claimant was
capable of light work such as clerical work. Claimant's attending
physician, while noting that most of the claimant's symptoms were without
objective medical support, but were subjective, was of the opinion
claimant was unable to work. Claimant performed the usual household
functions and drove a car when necessary. A vocational specialist,
summarizing the test results conducted by a rehabilitation center,
testified that the claimant demonstrated significant clerical skill
involving language usage, numerical ability, verbal reasoning, and
fluency, and good manual capacity for the fine hand manipulation. Another
vocational expert testified that the claimant had highly marketable
vocational skills currently in demand, listing types of jobs available in
the area in which she lived which she could obtain. Held, on the
basis of the medical and vocational evidence as a whole, the claimant's
heart condition, as reflected by the medical examination in September
1965, had not significantly improved as to establish that the claimant was
then capable of engaging in substantial gainful activity, and thus
claimant's disability ceased on September 3, 1965. Accordingly, the
claimant's entitlement to a period of disability and disability insurance
benefits terminated with the month of November 1965, pursuant to sections
216(i) and 223 of the Act.

This case is before the Appeals Council on the claimant's request for
review of the hearing examiner's decision dated October 28, 1966. The
hearing examiner held that the claimant's entitlement to a period of
disability and disability insurance benefits ended with the close of the
last day of November, 1965.

The claimant filed an application for a period of disability and for
disability insurance benefits on June 22, 1964 alleging inability to work
from December 1, 1963 because of a heart disorder. On the basis of this
application, it was determined that the claimant became disabled on
December 1, 1963. Subsequently, it was decided that medical evidence
established that as of September 1965, the claimant's condition had
improved to a degree which would permit her to return to substantial
gainful activity within the scope of her vocational training and
experience.

STATEMENT OF THE LAW AND ISSUES

Section 404.1539(a) of the Social Security Administration Regulations No.
4 [20 CFR 404.1539(a)] provides that an individual's "disability" shall be
found to have ceased in the month in which the impairment, as established
by the medical or other evidence, is no longer of such severity as to
prevent the individual from engaging in any substantial gainful
activity.

Section 216(i) of the Social Security Act, as pertinent herein, provides
for the establishment of a period of disability and, in effect, that such
period shall end with the close of the last day of the second calendar
month following the month in which disability ceases.

Section 223 of the Act, as pertinent herein, provides for the payment of
disability insurance benefits and, in effect, that entitlement to such
benefits shall end with the close of the second month following the month
in which the disability ceases.

The general issues before the Appeals Council are whether the claimant
continues to be entitled to disability insurance benefits and/or a period
of disability. The specific issues are whether the claimant's disability
has ceased, and if so, as of what date. This depends on whether the
evidence establishes that the claimant's impairment has improved
sufficiently so that it is no longer of such severity as to prevent
substantial gainful activity.

SUMMARY OF MEDICAL AND VOCATIONAL EVIDENCE

The medical evidence before the hearing examiner showed that the claimant
was admitted to a hospital in April 1964 because of difficulty in
breathing. She was treated and was ultimately discharged on May 23, 1964
with a final diagnosis of arteriosclerotic heart disease with cardiac
decompensation, and anterior myocardial ischemia.

Shortly after discharge from the hospital, the claimant's attending
physician reported that under his care there had been excellent response
to medication, and that there were no longer any objective indications of
heart disease. He was of the opinion that the claimant would probably
become completely symptom-free, but that she should avoid strenuous
exertion.

In September 1964 (about 4 months after hospitalization) a specialist in
internal medicine examined the claimant and reported that an
electrocardiogram gave the impression of: "Myocardial change and/or
digitalis effect. First degree block." His diagnoses included
arteriosclerotic heart disease, manifested by angina pectoris, and
congestive heart failure. However, he recommended re-evaluation of the
claimant's medical status in about a year because of the possibility of
reversible disease.

Since said internist had suggested the possibility of improvement, the
claimant was re-examined by him in September 1965. Medical findings
revealed that her chest was clear and free of signs suggesting heart
failure. Urinalysis and blood studies were within normal limits; and most
significantly, the electrocardiogram, when compared to the tracing of
September 1964, no longer demonstrated the previous indications of heart
block or other diagnostic abnormality. The internist interpreted this
tracing to be a normal electrocardiogram. In conclusion, he stated that
although there had been no subjective change, the claimant did not relate
a typical history of angina pectoris. Moreover, at the current examination
the electrocardiogram had reverted to normal and there was no objective
evidence of significant heart disease. Apparently, the paucity of
objective medical findings that could be attributed to heart disease
prompted him to conclude that "the previous appraisal may have been
somewhat in error, or at least the patient's condition has improved
significantly despite the fact that she does not think that it has." He
was of the opinion that the claimant was now perfectly capable of light
work, such as clerical duties not involving heavy labor. He considered her
prognosis good with proper orientation and motivation.

The claimant's attending physician, in a medial report dated December 6,
1965 also expressed the opinion that most of her symptoms were without
objective medical support but were solely subjective in nature. However,
he advised against a job requiring "physical exertion." In another medical
report dated July 27, 1966, submitted by the claimant's attending
physician, he indicated that subsequent to the sole episode of cardiac
decompensation, her objective medical findings returned to normal.
Specifically, he stated that her heart has returned to normal size; the
claimant's lungs had cleared, her electrocardiograms had reverted to
normal, and her blood pressure had remained controlled with medication.
However, apparently because of her continued subjective symptoms, he
expressed the opinion that she is unable to work.

In view of the contrary medical opinion that light activity was possible,
an analysis of the claimant's vocational capabilities and potential was
obtained from the state rehabilitation center. Its report indicated that
the claimant's daily activities consisted of cooking, washing dishes,
dusting, and dry mopping. Also, that she enjoyed sewing, spectator sports,
attended her local church, and drove an automobile when necessary. Her
full scale I.Q. was calculated to be 108, which placed her within the
normal range of intellectual functioning. Her performance scores showed
that she achieved average or above average grades in vocational pursuits
that required fluency and verbal reasoning, i.e., business correspondence,
proofreading, etc. At least an average level of function was achieved in
those actions requiring eye and hand coordination, and fine
manipulation.

The vocational specialists summarized the test results as meaning that
the claimant had demonstrated significant clerical skills involving
language usage, numerical ability, verbal reasoning and fluency, as well
as good manual capacity (eye-hand coordination) for fine hand
manipulation. It was their considered opinion that she was cooperative,
but not particularly well motivated. She frequently complained of fatigue,
chest pain, dizziness, and numerous other bodily discomforts. They
indicated that if these symptoms were present to the degree that she
expressed, she could not be expected to secure or maintain a gainful job.
Nevertheless, in their opinion she possessed significant work skills, and
could be expected to return to gainful employment within the scope of her
previous occupational area, if she could be successfully rehabilitated.

To supplement the rehabilitation center's report and to define the
claimant's actual employability, a vocational expert was called to testify
at the hearing. He stated that he had made a careful review of the
claimant's occupational background and experience. On the basis of his
evaluation he stated that even if all of her subjective symptoms could be
adequately substantiated by objective medical findings, she would still be
employable.

In support of this conclusion the expert pointed out that the claimant's
clerical work had been sedentary and that the work which she admitted
performing at home is heavier and more physically demanding than some
clerical work which she could do. After direct discussion with prospective
employers located in the general area where the claimant lived, it was the
vocational expert's opinion that she was reasonably able to compete for
jobs in small commercial establishments, or in various nonprofit
organizations. He considered these jobs more or less ideally suited to the
claimant's needs because the work pace was slower, and the job pressures
much less. The vocational expert determined that the claimant would
qualify for such jobs as a cataloguer in a library and a file clerk, and
that she had the capacity to perform various clerical duties at the
neighboring community college or court house. Also, he indicated that
there were sedentary jobs at the local hospital that required the
claimant's particular skills. Moreover, the expert was of the opinion that
the claimant would make a good receptionist or cashier. Other job
opportunities which he found available to the claimant were with local
financial institutions and real estate offices, where the hours are
relatively short and personal relationships more relaxed. He further
testified that the claimant could have her choice of position, and that no
job placement problem need be expected. The vocational expert concluded by
indicating that it was not necessary to retrain the claimant for other
types of work and that the jobs for which she qualified existed in or
around the area in which she resided.

Medical evidence in addition to that before the hearing examiner included
a more complete clinical record in connection with the single episode of
hospitalization in 1964 for treatment of cardiac decompensation and
anterior myocardial ischemia. This hospital summary also indicates that
the claimant had responded well to treatment and at the time of discharge
she was symptom- free.

The other medical statements dated October 12, 1966 and November 1, 1966,
indicated that the claimant continued to have symptoms of dyspnea and
angina with evidence of cardiac abnormality. Dr. P, who examined the
claimant in September and October 1966, recommended continued dietary
control along with the avoidance of heavy exertion, exposure to cold or
emotional upset. He believed that she would do well to continue at light
activity.

EVALUATION OF MEDIAL AND VOCATIONAL EVIDENCE

The question before the Appeals Council is whether the claimant continues
to be disabled. In resolving this issue, the Council must decide whether
the medical evidence establishes that the claimant has improved to a
degree sufficient to permit resumption of substantial gainful activity. In
reaching its conclusion, the Appeals Council will consider not only the
medical evidence but such factors as the claimant's age, education,
training, and occupational background. However, it is essential to bear in
mind that mere self-serving allegations of inability to work as a result
of impairments causing shortness of breath, lack of bodily functions,
etc., must be adequately confirmed by objective evidence, preferably
including appropriate clinical and laboratory diagnostic
techniques.[1]

The medical evidence clearly established that the claimant had
experienced an episode of cardiac decompensation in about May 1964. With
appropriate treatment significant improvement is shown to have taken
place, and at the time of her discharge from the hospital, her vital
functions were operating normally and she was symptom-free. Repeated
studies, and findings by the claimant's attending physician over a
considerable period of time, consistently indicate the sustained course of
the initial improvement. In other words, it has been established that the
claimant's heart, with treatment, has remained compensated. Specific
studies reported by both the claimant's physician and the specialist in
internal medicine revealed that her heart size had returned to normal, her
chest had become clear, her electrocardiograms had reverted to normal, her
laboratory studies were within normal limits, and her blood pressure
remained controlled. Significantly, there were no longer signs of
myocardial ischemia (decreased blood supply to the heart muscle). Although
the claimant's physician in his last report (in contrast with his previous
report), stated that there were definite cardiac abnormalities, he did not
describe the type or degree of abnormality present. In any event, on the
basis of widely separated examinations, it was found that clinically, the
claimant was substantially improved over her condition in 1964. Moreover,
the more persuasive medical opinion is to the effect that while it would
be inadvisable for the claimant to undertake heavy exertion, or risk undue
emotional stress, light activity would be beneficial to her. The
specialist in internal medicine specifically stated that the claimant was
capable of doing clerical work.

Based upon the medical conclusion that the claimant was capable of at
least light activity, an impartial vocational expert testified that she
had highly marketable vocational skills currently in demand, and that she
had an excellent employment potential. In reaching his conclusion, the
vocational expert stated that he had personally investigated the
employment possibilities available to the claimant and that no placement
problem need be expected.

On the basis of the medical and vocational evidence as a whole, the
Appeals Council concludes that the claimant has a medically determinable
heart condition for which she received treatment; that this treatment
brought about significant improvement, and that as established by medical
examination in September 1965, the claimant now is capable of light work
activity. The Council further concludes, based on the vocational evidence
of record, that there are many suitable jobs in the claimant's labor
market for which she can reasonably compete.

FINDINGS OF THE APPEALS COUNCIL

After careful consideration of the entire record, the Appeals Council
makes the following findings:

The evidence establishes that the claimant's medical condition had
improved by September 3, 1965 to a degree which permitted light work
activity.

The claimant has regained the physical capacity to perform substantial
gainful activity within the scope of her previous training and vocational
experience.

Jobs for which the claimant is qualified are readily available to her in
the area in which she resides.

The claimant's inability to engage in substantial gainful activity by
reason of her impairment continued from December 1, 1963 to September 3,
1965, but not thereafter.

The claimant was under a "disability" as defined in the Act which
commenced on December 1, 1963 and continued to September 3, 1965, but not
thereafter.

DECISION

It is the decision of the Appeals Council that the claimant's disability
ceased in September 1965, and that her entitlement to a period of
disability and to disability insurance benefits ended effective with the
close of November 1965. The decision of the hearing examiner is affirmed.
Date: August 1, 1967